Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial

Objective

This study aimed to evaluate the success of implementing outpatient schema focused therapy (ST) for borderline patients in regular mental healthcare and to determine the added value of therapist telephone availability outside office hours in case of crisis (TTA).

Methods

To enhance the implementation, the following adaptations regarding the original ST protocol were applied: a reduction in the frequency and duration of the therapy; training therapists of eight regular healthcare centers in ST with a structured and piloted program supported by a set of films (DVDs) with examples of ST techniques; training and supervision given by Dutch experts. Telephone availability outside office hours was randomly allocated to 50% of the therapists of each treatment center. Patient's outcome measures were assessed with a semi-structured interview and self-report measures on BPD, quality of life, general psychopathology and an ST questionnaire, before, during and after treatment.

Results

Data on 62 DSM-IV defined BPD patients were available. Intention-to-treat analyses showed that after 1.5 years of ST 42% of the patients had recovered from BPD.No added value of therapist telephone availability (TTA) was found on the BPDSI score nor on any other measure after 1.5 years of ST.

Conclusions

ST for BPD can be successfully implemented in regular mental healthcare. Treatment results and dropout were comparable to a previous clinical trail. No additional effect of extra crisis support with TTA outside office hours ST was found.     

Ranald Macdonald and statistical inference

Ranald Roderick Macdonald (1945–2007) was an important contributor to mathematical psychology in the UK, as a referee and action editor for British Journal of Mathematical and Statistical Psychology and as a participant and organizer at the British Psychological Society's Mathematics, statistics and computing section meetings. This appreciation argues that his most important contribution was to the foundations of significance testing, where his concern about what information was relevant in interpreting the results of significance tests led him to be a persuasive advocate for the ‘Weak Fisherian’ form of hypothesis testing.     

Comparing Fixed-Point and Revision Theories of Truth

In response to the liar’s paradox, Kripke developed the fixed-point semantics for languages expressing their own truth concepts. (Martin and Woodruff independently developed this semantics, but not to the same extent as Kripke.) Kripke’s work suggests a number of related fixed-point theories of truth for such languages. Gupta and Belnap develop their revision theory of truth in contrast to the fixed-point theories. The current paper considers three natural ways to compare the various resulting theories of truth, and establishes the resulting relationships among these theories. The point is to get a sense of the lay of the land amid a variety of options. Our results will also provide technical fodder for the methodological remarks of the companion paper to this one.     

Updating objects in visual short-term memory is feature selective

The purpose of this study was to examine whether the process of updating information in visual short-term memory (VSTM) is object based. We investigated whether modifying the memory of one feature of an object would automatically promote refreshing the memory of all of its other features. The results showed that the facilitative effect of updating was specific to the updated feature of an object and did not spread to its nonupdated features. This feature-selective effect suggests that updating VSTM is not object based (Experiment 1), even though storage was object based (Experiment 2). Control experiments ruled out strategy-based (Experiment 3) and stimulus-related (Experiments 4–6) accounts. Feature-selective updating may indicate that the mechanism used to modify the contents of memory may have a different basis than that used to encode or store information in memory.     

A multistream model of visual word recognition

Four experiments are reported that test a multistream model of visual word recognition, which associates letter-level and word-level processing channels with three known visual processing streams isolated in macaque monkeys: the magno-dominated (MD) stream, the interblob-dominated (ID) stream, and the blob-dominated (BD) stream (Van Essen & Anderson, 1995). We show that mixing the color of adjacent letters of words does not result in facilitation of response times or error rates when the spatial-frequency pattern of a whole word is familiar. However, facilitation does occur when the spatial-frequency pattern of a whole word is not familiar. This pattern of results is not due to different luminance levels across the different-colored stimuli and the background because isoluminant displays were used. Also, the mixed-case, mixed-hue facilitation occurred when different display distances were used (Experiments 2 and 3), so this suggests that image normalization can adjust independently of object size differences. Finally, we show that this effect persists in both spaced and unspaced conditions (Experiment 4)—suggesting that inappropriate letter grouping by hue cannot account for these results. These data support a model of visual word recognition in which lower spatial frequencies are processed first in the more rapid MD stream. The slower ID and BD streams may process some lower spatial frequency information in addition to processing higher spatial frequency information, but these channels tend to lose the processing race to recognition unless the letter string is unfamiliar to the MD stream—as with mixed-case presentation.